Provider Demographics
NPI:1578585816
Name:GUTIERREZ, MARIA E (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:E
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11135 S JOG RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-1807
Mailing Address - Country:US
Mailing Address - Phone:561-374-8969
Mailing Address - Fax:561-374-8929
Practice Address - Street 1:11135 S JOG RD
Practice Address - Street 2:SUITE 5
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-1807
Practice Address - Country:US
Practice Address - Phone:561-374-8969
Practice Address - Fax:561-374-8929
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM81294174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6183ZMedicare PIN